Mohammad, Mazniza'in
(2010)
A comparison between metoclopramide and
promethazine plus pyridoxine in the
management of hyperemesis gra vidarum: a
randomized controlled trial.
Masters thesis, Universiti Sains Malaysia.
Abstract
Hyperemesis gravidarum is a debilitating condition, involving the
general health and psychological aspects of the patients, as well as creating financial
burden to the family. An effective treatment will be very much beneficial in reducing
these stressful conditions. The mainstay treatment for hyperemesis gravidarum is to stop
the bouts of vomiting, rehydration as well as correcting the starvation state of the patients.
A lot of antiemetics have been widely used as the first-line treatment. However, their
efficacy has never been compared, thus the aim of this study. This study was performed to compare the efficacy of
metoclopramide with the combination of promethazine and pyridoxine as antiemetics in
patients with hyperemesis gravidarum. The efficacy of either regime was measured by the
mean PUQE score achieved after treatment, the duration taken to clear the ketones in the
urine, duration of hospital stay as well as the side- effects encountered. Patients admitted to Ward 1 Utara of Hospital Universiti Sains Malaysia
with hyperemesis gravidarum were randomized to receive either metoclopramide 1 Omg
three times a day or combination of promethazine 25mg three times a day with pyridoxine
20mg three times a day. The degree of vomiting was assessed by using the PUQE score,
performed at 12, 24, 36, 48, 60 and 72 hours after administration of each regime. Ketone in
the urine was quantified daily. The duration of hospital stay as well as the side- effects
encountered were compared. A total of 60 patients were recruited with 30 patients in each regime.
There was no difference in the PUQE score of patients receiving metoclopramide with
those receiving combination of promethazine and pyridoxine after 72 hours of drug
administration (5.4 ± 1.4 versus 5.3 ± 1.6 respectively, p > 0.05). The duration taken for
urine ketone clearance did not significantly differ either (2.03 ± 0.61 days for
metoclopramide group versus 2.26 ± 0.63 days for the combination of promethazine and
pyridoxine group; p value= 0.15). Both groups of patients have mean hospital stay of about
three days. More than half of the patients in the combination of promethazine with
pyridoxine group were sedated after the drug administration. Both regimes have similar efficacy as antiemetic in patients with
hyperemesis gravidarum, and may be used as the first-line antiemetic in such cases.
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